Mark Pendergrast

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Mark Pendergrast speaks at universities, schools of public health, business conferences, management seminars, and psychological meetings. His presentations are tailored to his audience but are always entertaining, thought-provoking, and challenging. Contact him to arrange an event. Click here for links to speeches, TV, and radio appearances. Click here for comments on his presentations.

Diarrhea death toll

March 28, 2010

In the United States, diarrhea is usually considered a nuisance, the subject of jokes.  But in the developing world, diarrhea kills some 2 million children a year.  It is the third leading cause of death in children under five, and the leading culprit is unclean water.  In 2006, I followed EIS officer Ciara O’Reilly in rural Western Kenya, near Lake Victoria, as she and her colleagues assessed the impact of the Safe Water System (SWS) in selected elementary schools.  In Inside the Outbreaks, in Chapter 22, I wrote about this trip.  Earlier in the book I explained the origin of this inexpensive, low-tech solution.  It started with horrendous cholera outbreaks in Africa and then in 1991 cholera leapt to Peru, the first appearance in Latin America in nearly a hundred years.  If untreated, cholera can kill within 24 hours due to dehydration.  (My book also relates the invention of “oral rehydration solution,” a life-saving drink, but that’s another story).  EIS officers discovered that even when water was properly treated to kill bacteria, it was often re-polluted when people dipped water out of storage containers, since their hands carried the germs.  So the CDC began to supply not only a dilute bleach solution (called WaterGuard in Kenya) but to provide narrow-mouthed water containers, the opening too small to allow a hand to enter.  There are spigots near the bottom.

As I saw in rural Kenya, the Safe Water System works.  Absenteeism and illness among students in the schools were down in contrast to the control schools without the program.  I also saw the source of the water some of the schools were drinking.  A ten minute walk from one school led to a stagnant pool of fetid water.  As we watched, emaciated cows, their ribs showing, came over to drink.  An old man, a member of the local Luo tribe, also came up and began to yell across the ravine, waving his arms and pointing at his head.  Our translator told us what he was saying.  The water made people sick, crazy in the head.  A local Catholic charity had promised to dig a well, but then the priest spearheading the effort was killed in a car crash, and it never happened.  Please help!

Obviously, the Safe Water System is a stop-gap measure.  In an ideal world, all people should be able to turn a tap and fill a glass with clean water.  But the huge cost of this infrastracture improvement is unlikely to be diverted from our spending on weapons, etc., in the near future.  So in the meantime, the SWS is a valuable tool.  After her two-year EIS service, Ciara O’Reilly, an Irish native, stayed on with the CDC in Atlanta and is working to bring cleaner water to the world.

Studies in seven countries on three continents have yielded a consistent result: use of the SWS decreased diarrhea risk by around 40% (though it does not kill viruses – rotavirus is a major child-killing cause of diarrhea, the subject of another blog perhaps).  Through partnerships with dozens of organizations from all sectors (private, NGO, UN, governments, community groups), the Safe Water System has been instituted in over 20 countries and protects three million people per month.  CDC and its partners are now trying to figure out how to get the SWS to more people — particularly the world’s poorest people.  The CDC has engaged schools, clinics, and HIV self-help groups to expand access to ever-more-remote locations.